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00307
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PDTNAM COQN a I DEPAHTIYffiiPl OF HEALTH 3
Divbtilon of Envieanm�W HeaN6 Servks* Coemel, N.Y 1031?
Eo&OW Must Provide
,C H D Permit N
CATE..OP, CONST8UC170N C6 MPL1ANCE FOB SEWAGE DISPOSAL SYSTEM.
.T
. - own or'V01aQe' . �
V.\ \)IJ
C
Located at i�^' -may '�\ - Tail M+p ._Block Lota�
- Owner /appUnmt Naoie ` wo E OM �` ormeil C Sabdlvlalon Name
Addres6 :, Subd Lot 3
in7 ny #
Fee; Enclosed; "Amount (�.. -%. , . , Dat:e Permit Issued �,Zz 6 t•,
Separate Sewemje'Syet@iii bWh by `` Addeew
Conatatbtg of \ 2�PJ GaUOu Sepdc Tank and
1
Water'Sapoy :. PitbUa Sotpply From Address
ors Private SdPP�Y Drilled by Address
ac QChcd H as Erosi
e TY&
r -Lot Size Ort - (`nntI-ri ltaan F'ninpl ato
UR9-
Npmber of Bedrooms; Hai Garbage Grinder,Been IoetalledT% i
Other
Begohementr �• ` � .. .: F .
I ce tify that'the eyetea(a), as liited°�eervinq. the above premise's rare ,'con tructed es, entia y hb she plena of she ca�lated work (copt'ae' '
of Which are 'attached), and iri; accordance With the standards, rules and r etio ac rdan w th` filed. plan, and the permit le ed by the
Patr�= county''De ant Of Health-
Oats ': !ai cirt-ifflW by P H. RA
.'Add
2'T Z p '"'x �i fl( ` • �c�6 LICanM Nom
1
4 1 1 • � i = lf.t a ... . .
co y perm reeult{nq fro m
M. a ISN'serm. i the'a al ve eYeter6($) shall Promptly take iliCh aetbll of may a neogNry to Meun tM'ewradbh of any'Yflsanleary -i
Any pMeori oecuOYM!Y pnmiaea.fe►wd.bY tM abo
Approval-0 tM ";Saparate`. iawerapi= shall become null and voW as aoob as a pubtl: pnitary --win beoo:eee
available and'th#.,approval of tfie, private water supply s'mll become "null vo vvMn a :publk -water supply becomme available. Such-111W ali ire ;. dA i Subject to mod {f foIt change when, in tM `_iudympnt of tM °Co I of N Ith.'' rNOptbn,' modNkatbn or ehsn/a N •Meewry.
Oafs BY ` l TItN
3/.89
Yorktown Medical Laboratory, Inc.
321 Kear Street
Yorktown Heights, N. Y. 10598
(914) 245 -2NO
Director: Albert H. Padovani M. T. (ASCP)
T- ELDORADO HOMES INC.
C/0 RON PAGANO
769 KIMBALL AVE.
YONKERS,NY. 10704
L
1
J
LAB N �.
Date Taken: 7/28/89 Time: 11;20arr
Date Rc'd: -772- Time:
Date Reported: AUG. 72 1969
Collected By: agano
Referred By:
Sample Location: Kitchen Tap
Brimstone rd.
-vatterson.117.
Phone # -
Phone # — Sample Type:
Repeat Test? ( check each)
LABORATORY REPORT ON THE QUALITY OF WATER
INORGANIC NON- METALS mg /L MICROBIOLOGICAL CFU /100mL
_ Acidity
_ Alkalinity
Chloride
Detergents, MBAS
_ Hardness, Total
Nitrogen, Ammonia
Nitrogen, Nitrate
_ Phosphate, Total
_ Sulfate
_ Sulfide
Sulfite
GENERAL BACTERIA
_ Standard Plate Count
(CFU /1.OmL)
MEMBRANE FILTRATION TECHNIQU1E
Total Coliform 1
Fecal Coliform
—.Fecal Streptococcus
METALS (mg /L)
Copper
_ Iron
_ Lead
_ Manganese
_ Mercury
Sodium
Zinc
MISCELLANEOUS
pH (units)
Color (units)
Odor (TON)
Turbidity (NTU)
MOST PROBABLE NUMBER TECHNIQUE
Total Coliform Index
Fecal Coliform Index
KEY FOR TERMINOLOGY
CFU =
Colony Forming Units
CON =
Confluent (q.v. TNTC)
LT =
C = Less Than
GT =
> = Greater Than
N/A =
Not Applicable
S/A =
See Attached
TNTC =
Too Numerous To Count
REMARKS
/COMMENTS (For Lab Use)
Potable
Non- potable
STP I N F
_ STP EFF
Other:
Sample Status:
(check each)
Outgoing
HNO3
_ HC1
_ H2SO4
_ NaOH
_ ZnOAc
Na2S203
Other:
Incoming
LE
k °C
GT
40c
_
pH
LE 2
pH
GE 9
_ pH
GE 12
Other:
ELAP No. 10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE (Was) (Wasn't) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH ORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE ®RIN'% ION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) (Didn't) MEET THE
SATISFACTORY AEMICAk. QUALITY STANDARDS OF THE NEW YORK PUBLIC WATER
CODES, FOR TAE R ET .RS TESTED, AT THE TIME OF SAMPLE COLLECT
/X/ \__A_i -Wj
Albert H. Padovani, M.T. (ASCP
, Director
2 /86(Rvsd7 /87)RWE
M
SAM�G
WELL COMPLETION REPORT
office Use Only
J
,a�
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
Y0
PUTNAM COUNTY DEPARTMENT OF HEALTH
WELL LOCATION,�,�,�j
EET ADDRESS. TOW VILLAG11CH Y TAX GRID NUMBER:
,
E: ADDRESS:
:0 PRIVATE
WELL OWNER
2 a c
❑ PUBLIC
USE OF WELL
®. RESIDENTIAL ❑ USL SUPPLY O AIR/COND./HEAT PUMP ❑ ABANDONED
1 - primary
O BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑. OTHER (specify)
2 - secondary
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE gal.
REASON FOR
O -NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
DRILLING
O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
966,
STATIC WATER LE�j ft.
TH .
DEPi
DATE MEASURED
DRILLING
'.ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
EQUIPMENT
O WELL POINT ❑ CABLE PERCUSSION O OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. -,126 OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH it
MATERIALS: STEEL O PLASTIC ❑ OTHER
CASING
LENGTH.BELOW GRADE m ft.
JOINTS: ❑ WELDED THREADED ❑ OTHER
DETAILS
DIAMETER in.
SEAL: O CEMENT GROUT ❑ BENTONITE,OTHER
WEIGHT
PER FOOT Z lb./ft.
DRIVE SHOE YES ❑ NO
LINER: ❑ YES ,CVO
SCREEN
DIAMETER (in)
SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (It)
DEVELOPED?
DETAILS
FIRST
O YES ONO
SECOND
HOURS
GRAVEL PACK
O YES
GRAVEL
DIAMETER
TOP
BOTTOM
O NO
SIZE
OF PACK in.
DEPTH ft.
DEPTH It.
WELL YIELD TEST tt detailed pumping
D P 9
WELL LOG It more detailed formation descriptions or sieve analyses
are available, please.attach.
METHOD: O PUMPED
1 tests were done is in-
DEPTH FROM
water
We1l
COMPRESSED AIR
, formation attached?
❑ YES 0 NO
SURFACE
Bear-
ing
Oia-
meter
FDRfdATtON DESCRIPTION
CODE
O BAILED ❑OTHER
tt.
l�
In
WELL DEPTH
DURATION
ORAWOOWN
YIELD
Land
Surface
#r,
It.
hr. min.
ft.
gpm.
0,
WATER ❑ CLEAR
TEMP.
QUALITY O CLOUDY
HARDNESS
O COLORED ANALYZED? O YES O NO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE
PUMP INFORMATION
CAPACITY GAL._
TYPE
CAP ITY
WELLORILLE�NAME ��yy ,�`
s
OAT
MAKER
MODEL
DEPTH
V T GE HP
�SaT Y SIGilftRE
.1'
PUTNAM COUNTY DEPARTMr OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Owncr or 1'urchas"ar off Building
Building Constructed by
Location - Street
Municipality
Building Type
Section 1)1.ock J.ot
Subdivision Name
Subdivision Lot #
GUARAN'= OF SUBSURFACE SEDGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has been constructed as shown on
the approved plan or approved amendment thereto, and in accordance with the
standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good
operating condition any part of said system constructed by me which fails to
operate for a period of two years immediately following the date of approval of the
"Certificate of Construction Compliance" for the sewage disposal system, or any
repairs made by me to such system, except where the failure to operate properly is
caused by the willful or negligent act of the occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environinental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate was
caused by the willful or� negligent act of the occupant of the building utilizing
the system.
Dated this day of S� 19 A' Signature
Title
General Contxat�todl(Owner) - Signature
Corporation N (if Corp.)
Address
rev. 9/85
Mk
Corporation Name (if Corp.)
Address
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225-0310
October 1, 1990
Mr. Frederick Zenz, P.E.
292 Main Street
Nelsonville, NY 10516
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN SIMMONS. M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
Director
Re: Application /Eldorado Homes Inc.
Brimstone Road, Patterson
Memorandum
TO: All Engineers and Architects
FROM: John Karell, Jr., P.E., Director
SUBJECT: ADHERENCE TO SANITARY CODE
DATE: December 29, 1987
The Sanitary Code states that an application (.and its permit. are
not legal until all amounts required are paid and the Code implies
that'payments should be guaranteed payable.
All potential permittees and all those responsible for paying fees
for Realty Subdivision, Commercial Sewage and Individual Sewage
Disposal.___Systems, are to be advised that only CERTIFIED.CHECKS {
.OR .MONEY ,6RDEkS twill be accepted from now on. This will assure that
we are in compliance with local laws and that payment has indeed
been received prior to the issuance of official approvals.
ELDORADO HOMES, INC. 1232
103 SPRING VALLEY 9
MONTVALE, NJ 07645 �
19 90 50- 7098/2219
PAY ��� ,,.�Q ,� Q /./n,� n . - ... .:. .:.1.....
TO THE ORDER OF /n�-I
uF um T nn Jwjl s n l �! DOLLARS
:a Putnam County
' Savings Bank s
BREWSTER, N.Y. 10309
FOR
00 12- 3 2I's 1: 2 2 L9 709801: 898 060 2 L4 L1I'
_y_ _ n �91fi- Fn. ^ ?131N7ij °i�'1C(n't. ia!!!n7�°F-- `�n'TI -71�ti y
g1n ,r SITE INS T -C?'M
J
ii
--
_ S'u`CDI'I?�S1CN-I L:lr
• i Lf �;� /�
1 v:
SDc = as F_Y arrmrovea Flans
b_ p= i 1 s = cz - Dat_ of plat- -r�---r1L J
�rr.e_' . LG=r; yv I _�i ��iC_DFnd
2:1
SC;_ P.CL etT1LL _ C^C area-
d- Stone, trey etc:-, arearer- t--F-n 15' fran �- a-G -
e. in0 ft_ frC ,HG =�'' C urr=
I DlSf r_ S c F- I
tr____c_ - 1,000 1,2-`0
b- S ti C
C. i ��' m: n'riL:, fCUr ? Ori
r_'CUi=. W1�Ri 10 f = cf Cc, Lan
c �Q �
e.
All C. sts at el
Pict = = : C:a f -c
_- CYlC= =1 soil i �� vc =" bcx �rG i=- -c= eS
2
Tan
L_ DICE - =n -
LTst rrd:�c to c1 =�
Di_ == =rc=- canter to c_ =L_r
$'rce C-f aC::=_:L=h1e 1/! - 1/32
6. 10 �'-_+ 1-- - Lr = _- _` Lr_` ' Cris i
7. L� '-'' < ?Q Lac: - =- t
5. RCCn ami = `cr Er- =r'_5ic , 50;
9. Size c= c avell 3/4 - 1-f d; =_- I
U . TES u'i C= c— ' Q In t= c nth 12"
Fire e_ c-=
h _ 'EDT CR LCSE
1. size c' L c a �cer
2. CLe 1c-, -_-_k �
to Cr ade
6. C`Tc1e w _ _ __ -= by c�i u'7
es iTint_ = =cN per c- c.e -
IV. F--::US=
1CCr
a. j1G! 1CC G� cS L�r cTrrCtic:' p ant
f: SZE ft-
c_ zinc 18" � � �e ara -s-
G_ arC.0 °--
4 =_ cv— 4rCF�`_?�=
a_ Epees rrcc- _-; c-cut
L
C. :_�� FZLCC _'_� -•i with Inside of Lc`
cent=._' n= s tones < a" in
e. Cart in c ..-,: in_L_ 11 acccrdi_^_c to Finn
C_ taro C=_ C -t=all LCC�S! =� &
C_ iL`CL.S1C G=- G: =C - ^_cr ° cSVGV t ::an EDS Sr=
1'_ C•.:._ .�C� :vc_— CrCt='__C:Z GCE='L?.��
vSiCn CC C=Ci crcv2.c— CP_ SiCres cr °. ^.:�'" t"'—" i =� -
C
I reprbsent,that 1 am, wholly and'completely.fet
above` described will be constructed as shown on
County en
Departmt • of HSatth,';`sntl tha {ome
be submitted' to the Department,; and -a writl
place,in good,.''' ahnq;eondition sny, part, "t
aece: of.the, approval ofAhe Ceifihcate of 6
w111 be located as shown on the approvef7;planar'
County Oepartnfent Of HSikh-
!ate . 31.- ;Mar:ch., 19,88• T�
Address Rnq
APPROVED FOR CONSTRUCTION This appr
revocable for -ma be amended 'or moC
requires 8 ne p rmi provetl for .dispU ON
Rev..
Date
's.
ble for,the design and location of ;the` proposed fyStem(S) 1) that the - separate' sewage disposal
ipprovedpmendment thereto and In,`accordance withahe standards; rules an r lationsof the
aUon thereof a "Cerbficste :oi Gonst uction;Complia�ce' satisfactory to the Commissioner of Healthwill'
larantee .will be furnished the owner, his successors; fieirs or assgns by .the builder, that. said'builAer will
d sewsge`disposat
system during theKperiod:df i 'i'Q1•.yeers Immediately'following,thedate of ilia Isw-
ictlon Compliance 'of the oiginal iy',stem briny repairs theretd;�2) that. ilia tlrilled well tlesc►ibed vbow ,
it said accoidance with the'ftandar..s,.,rules'and`requa ons, Of the Putnam.
Signed ..
P.E. _ R.A. —
License No 29206 -
ticpues t o yoari t[om the„d to issued unless -of of tha building has been undertaken and is
when'c sid d,necessar the Commissioner of Health. Any change, or alteration of construction ..
domest]san�it>�Y,PCSDliv_ate weer 3LPply only.
BY ::, Title
it
. PUTNAM 'COUNTX.DEPARTMENTOP :HEALTI3
��� ;. Dlvielori'ot En Seavloelf Caemel N Y .1051? ,:: _ weer to Provide P" N `
o ®CERTIFICATE OF CO LIAN
CONSTRUCTION PEiINQT FOR: SEWAGE DISPOSAL SYSTEM
.,
1
1.-
T." Pa t on
Iacated:at Brimstone road
ownsor YtOage
Subdivision Name Card one` c.a.a. Lot M 3
Tai Map 1 g. Bloch 1. Lot
Ltenewal� p • ,Revtsbo ❑ S
Otrnei/ tName E. /E::' -` &. C. /P...Cardone
APPS
'
_
,:Date "ot Previous' royal ` .
MaimeAaal�e.a 344 Wi11 -is Ave
�gwoHawthoriae NY �p1. 1053`2
Bwili Fratrie Lot Area : 2 $9
•,
Fitt Secaoo Only X `,. DeP 2' Volume 457. cu Yds.
Number d Bedrooms Four Design Flow -G P• D 800
Plum Nod&,tlon is Beguired Wien FW le cotapleted .
Septtes<te Sewerage System to consist of Uon Septk Teak ana 500 LF
ids trench'
To be twnstrticted by :' Addreee
Watee Su Poly: Pdblif ,Stlpply,.From ' ` '' Addreae'
e %,' ` PrWntesnnPlr;lleWedbyP F Beal & Sor
Rte 6, Brewster, NY. 1050.9
I reprbsent,that 1 am, wholly and'completely.fet
above` described will be constructed as shown on
County en
Departmt • of HSatth,';`sntl tha {ome
be submitted' to the Department,; and -a writl
place,in good,.''' ahnq;eondition sny, part, "t
aece: of.the, approval ofAhe Ceifihcate of 6
w111 be located as shown on the approvef7;planar'
County Oepartnfent Of HSikh-
!ate . 31.- ;Mar:ch., 19,88• T�
Address Rnq
APPROVED FOR CONSTRUCTION This appr
revocable for -ma be amended 'or moC
requires 8 ne p rmi provetl for .dispU ON
Rev..
Date
's.
ble for,the design and location of ;the` proposed fyStem(S) 1) that the - separate' sewage disposal
ipprovedpmendment thereto and In,`accordance withahe standards; rules an r lationsof the
aUon thereof a "Cerbficste :oi Gonst uction;Complia�ce' satisfactory to the Commissioner of Healthwill'
larantee .will be furnished the owner, his successors; fieirs or assgns by .the builder, that. said'builAer will
d sewsge`disposat
system during theKperiod:df i 'i'Q1•.yeers Immediately'following,thedate of ilia Isw-
ictlon Compliance 'of the oiginal iy',stem briny repairs theretd;�2) that. ilia tlrilled well tlesc►ibed vbow ,
it said accoidance with the'ftandar..s,.,rules'and`requa ons, Of the Putnam.
Signed ..
P.E. _ R.A. —
License No 29206 -
ticpues t o yoari t[om the„d to issued unless -of of tha building has been undertaken and is
when'c sid d,necessar the Commissioner of Health. Any change, or alteration of construction ..
domest]san�it>�Y,PCSDliv_ate weer 3LPply only.
BY ::, Title
it
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL Q /j
PCHD PERMIT �v
WELL LOCATION
Street Address
Brimstone Rd.
Town/Village/City Tax Grid Number
T. Patterson 18 -1 -6.13
WELL OWNER
Name Mailing Address
Cardone etal 344 Willis Ave. Hawthorne, NY 10532
CAPrivate
O Public
USE OF WELL
1 - primary
2- secondary
10 RESIDENTIAL
(3 BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
U INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT
5 gpm /# PEOPLE SERVED 8 /EST. OF DAILY USAGE 800 gal
REASON FOR
DRILLING
UNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL
O TEST OBSERVATION
DETAILED
REASON FOR
DRILLING
New Residence
WELL TYPE
XODRILLED
ODRIVEN
ODUG
®GRAVEL
C]
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
.Cardone Lot No. 3
WATER WELL CONTRACTOR: Name P.F. Beal & Sons, Inc. Address:Rte. 6, Brewster, Ny 10509
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Over one mile
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED(see dwg.# #,,Job #S.0.2461 By John H.
[:]ON REAR OF THIS APPLICATION ®ON SEPARATE SHE T Prentiss, P.E,.
31 March 1988 i
(date) (signature
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
provided that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form prov ded by the Putnam County
Health Department.
Date of Issue: ?i 19
Date of Expiration: 2" 19 ermit Issutg ffi0 a
Permit is Non - Transferrable White copy: H. D. File
Yellow copy: Building Inspector
Pink Copy: Owner
287 Orange copy: Well Driller
JeUx am WULY11 1Jr rLitCllviMN1 Ur ^ cew111 — Ll V 1J1Vltl Vi .•..9 V J s�vlvl•1Cu►V , +„ ^ �'++� •111 J1 �L \V 14Lr7
INDIVIDUAL 'WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTFMS
REVIEW SHEET - CONSTRUCTION PERMIT.
I�.�.N IuI�I�Yh
Permit Application _
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions - Volume
D or J Box Detail
Septic Tank - Size, Detail
Well Detail, Service Line if P.WS;_
Trench /Gallery
Pump Pit
Two-Foot Contours Existing & Proposed
Slopes for Driveway Cuts
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area; shown; gravity flow
If Pm ped Pit & D Box Shown & Detailed
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary
House Sewer - 1 /4 " /ft. 4110; `type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Curtain,Stoxm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' from Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
.Data On DDS Plans & Permit Same
NOTES: 1: Tests to be repeated at same depth untiltapproxima equal soil rates
,ay : are obtained at . each percolati on': test hole: All : data to" be suliiiitted
for review.
2. Depth measurementsto be .made from top of hole. ,+;•
rev. 9/85
..DIVISION OF. HEALTH,:: SERVICES; •.::
DESIGN DATA SHEET- SUBSUFACE, , SEWAGE °DISPOSAL SYSTEM FILE Nd.+
Owner G.-14
r y� - . Address �� I wt57aA6 ,4/-44 Y'
Located at ; (Street) Sec:, Block Lot o •i 3
(.indicate near St cross street)
Municipality k
�4T1- -rR-Zbcm) be Watershed Cry5--r%c,
SOIL PERCOLATION TEST DATA RBWIRED TO BE SU MI= WITH APPLICATIONS
Date of Pre- Soaking �j'r .. Date of Percolation Test + —�
HOLE
D][grIDE�R; .. • CL=
TIME PEI tCOLATION : .
� ` . �... •. REROOLATION
Run
Elapse Depth to Water From Water Level
No.
Time .. ". Ground `Surface -In Inches Soil Rate
Start -Stop
Min. Start : -', Stop Drop In Min/In Drop.
;- Inches +' ,. +. Inches Inches,,
2 ' - 91
--
`3
NOTES: 1: Tests to be repeated at same depth untiltapproxima equal soil rates
,ay : are obtained at . each percolati on': test hole: All : data to" be suliiiitted
for review.
2. Depth measurementsto be .made from top of hole. ,+;•
rev. 9/85
TEST PIT DATA REQUIRED TO
DEPTH HOLE NO. / HOLE NO. -# Z
G.L.
4° Gsi...
5.1
.,:.
61 P87
7'
8'
mer �cq�
9'
10'
11'
12'
13'
APPLICATION ,r
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED �jb tj,F
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED p y G5,
DEEP HOLE 'OBSERVATIONS MADE BY:` 1 = DATE: �bA tYf�4�
DESIGN
Soil Rate Use-d,Y --15 Min /1" Drop: S.D. Usable Area Provided 5-amp ' f'
No. of Bedrooms Septic Tank Capacity -42-3-0 gals. Type
Absorption Area Provided By L.F. x 24" width trench
Q�pI ESS10Nq�
Other .C�► J S 5• o F
r,
Name Signature'
R09 FAIR.-ST 914 -878 -6170
Address CARMEL, NEW YORE( 10512 SEAL
"0. 29206
OF NE STAZt0
THIS SPACE FOR USE BY HEALTH DEPAM&U ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
LOT 4
o
r, •' t ji,jali /�' j0 j
oi)�i5y'14 ,A 12. II
wires /I
S, 43 °40100"E.
33.001 -
R. =
200-60' .
• � -�L: =. 105.0/:1 '
30°.05100
w
Y. O
L t
� G
J
v
S.l3 °35 l 00 11 E
1 86.60
i
1
\_ S:0 °54/00,1 E.
24.001
. .. ...._..may__ • ._ � .�--